How to Submit a Claim
Claims must be received by Sun Life no later than December 31 of the year following the calendar year in which the expenses were incurred. For example, if you incurred expenses in July 2017, you have until December 31, 2018 to submit your claim. The Plan Administrator has no obligation to recognize claims received beyond December 31 of the year following the year in which the expenses were incurred.
The amount reimbursed is subject to the provisions of the Plan and co-payment, as applicable.
To be reimbursed, you must submit a PSHCP claim and provide any required supporting documents. Supporting documents may include:
- Bills and invoices;
- Pharmacy receipts;
- Itemized statements from a physician or other medical practitioner; and
- Services, physiotherapy, and certain durable equipment.
How to submit an electronic claim:
You must register on Sun Life’s Plan Member Services website and sign up for direct deposit. You will need your contract number and member ID number which you will find on your PSHCP benefit card or your claim statement. You will also have to provide your banking information.
If you are already registered, you can submit a claim through both Sun Life’s Plan Member Services website or the my Sun Life Mobile application.
To submit a claim online:
1) Sign in to sunlife.ca/pshcp
2) Choose the appropriate claim type (e.g., paramedical, vision) and follow the steps to complete the transaction
There are several other web-specific features:
- Coordination of benefits: submit coordination of benefits claims between two Sun Life plans or submit the remaining balance of a claim already processed through another insurer.
- Positive enrolment: complete and update your positive enrolment information.
- Wellness: access health related resources.
Once registered, you can also submit a claim using the my Sun Life Mobile application. Download it for iPhone and Android devices at sunline.ca/mobile or from Google Play TM or the Apple App Store.
To submit a claim using the application:
1) Sign in to the application
2) Select Submit a claim
Additional features available on the mobile application:
- Photo submission: submit photos of receipts for more complex medical expenses, such as treatments lasting more than one hour, lab tests, equipment, and medical supplies.
- Send documents: provide supporting documentation requested by Sun Life, such as physician referrals and questionnaires for a claim.
- Apple Wallet: add your PSHCP benefit card to your Apple Wallet.
- Touch ID sign-in: activate this feature to log in to the my Sun Life Mobile app securely without a password.
Claims submitted through the my Sun Life Mobile application or online through Sun Life’s Plan Member Services website will be adjudicated immediately, and if they are approved, any reimbursement will be deposited into your bank account within 24 to 48 hours. Some claims may require additional time to be processed.
The following claims cannot be submitted through the Sun Life Plan Members Services website or the my Sun Life Mobile application:
- Out-of-country claims;
- Claims related to motor vehicle accidents;
- Claims related to work injuries;
- Drug claims; and
- Claims related to a dental accident.
How to submit a paper claim:
1) Complete the appropriate PSHCP Claim Form:
- If you have Supplementary Coverage, complete the PSHCP Claim Form. For expenses incurred outside of Canada, indicate the currency of your expenses. Your reimbursement will be converted to Canadian dollars.
- If you have Comprehensive Coverage, complete the PSHCP Out-of-Country Claim Form. Your reimbursement will be made in the currency of the country where you reside.
2) Attach supporting documentation (original receipts, bills, invoices, physician or practitioner statements, and/or questionnaires, etc.).
Please keep copies of your receipts, your completed claim form, and any other documentation provided. Originals will not be returned.
3) If you have Supplementary Coverage, send the claim by mail to the following address:
Sun Life Assurance Company of Canada
PO Box 6192 Stn CV
Montreal, QC H3C 4R2
Members in the National Capital Region can also leave their claims in a drop box located in the lobby of the Sun Life claims office, located at 333 Preston Street (south of the Queensway) in Ottawa. The reception area located on the 3rd floor is open from 8:00 am to 4:00 p.m., Monday to Friday, should you wish to discuss an issue with a customer service representative.
If you have Comprehensive Coverage, send your claim to Allianz Global Assistance:
Allianz Global Assistance
Public Service Health Care Plan
PO Box 880
Waterloo, ON N2J 4C3
The Plan Administrator will adjudicate your claim and issue a Claim Statement (explanation of benefits) along with a cheque for your reimbursement, if applicable. If you have registered for paperless services, you will be notified by e-mail that your claim has been adjudicated and that you can view your Claim Statement online. Your reimbursement will be deposited directly into your bank account (available in Canadian dollars only). You can register for paperless services and direct deposit by logging into your Sun Life account at www.sunlife.ca/pshcp.